Monday, 24 June, 2024
HomeTalking PointsMental illness often wrongly blamed for mass shootings – US psychiatrist

Mental illness often wrongly blamed for mass shootings – US psychiatrist

Mental health or psychological conditions are often used to explain mass murders, like the tragic shootings of 19 children and two adults in another school shooting in the US, but the reality is that mental illness rarely provides clues for such tragedies.

Writing for Medscape, US psychiatrist Dr Dinah Miller says when it comes to explaining mass murder, the camps divide: They are the result of some combination of mental illness, easy access to firearms, and terrorism and hate.

She says for psychiatry, there is a unique place in the argument – half of all mass shooters have exhibited signs or symptoms of psychiatric illness, and for those who want to deflect the issue away from issues related to the regulation of firearms, it becomes easy to blame “mental illness”, as though that explains it all.

Either the gunman “snapped” in such a way that no one could have predicted, or the mental health system is at fault for not preventing it.

There are many ways to be emotionally disturbed; mental illness is only one of them, and there is no psychiatric diagnosis that includes the symptom of shooting strangers, or shooting children. Most people, including nearly all psychiatrists, will never know someone who perpetrates a mass shooting.

Can mental illness give us any insight into these senseless killings? Sometimes, but rarely. Take John Hinckley, who shot President Ronald Reagan just to impress actress Jodie Foster. Sometimes these killings are motivated by delusional beliefs.

But the planning and preparation going into most mass shootings involves a degree of organisation and forethought we don’t typically see in those with severe psychotic disorders.

The other psychological explanation that satisfies some of a non-medical population is that these killers “just snap”. This, too, is a term not included in our diagnostic vocabulary, but it remains a way for some to explain that which can’t be explained. If mental illness, however, is the cause of mass murders, then more stringent gun control is unnecessary.

Every state already has a mechanism to prevent those with criminal and specified psychiatric histories from buying legal firearms, and it may be inevitable that these screens are not perfect.

The next line of thinking moves to the psychiatric “if only”. If only there were more state hospital beds and if only it were easier to compel people with psychiatric disorders to get treatment against their will, then we could eliminate these crimes. The Virginia Tech shooter was mandated to get outpatient psychiatric treatment after a brief hospitalisation, yet he never went and there was no mechanism in place to track him.

In cases where a person with a psychotic illness has a history of repeated violent episodes after stopping medications, it does make sense to mandate treatment, not because they are likely to shoot strangers, but because some people do become violent when they are ill and mental illness is believed to play a role in 10% of murders.

Mass murders remain rare, and while advocates for legislation that would make it easier to mandate involuntary care have cited violence prevention as a reason, it is hard to imagine we would force people to get care because they “might” commit such a crime — unless there was convincing evidence that someone was at risk of committing such a heinous act.

For those who oppose stronger gun control laws, the “what if” may circulate around the need for even more firearms. What if teachers carried guns? What if schools were more heavily policed? What if the criminals were made to be afraid?

We are left with the fact that other countries do not see these numbers of mass shooting events, yet mental illness is ubiquitous. Mental illness is not unique to the US, however, the number of available firearms is. In a country of 323m people (including children and people living in institutions with no access to firearms), there are estimated to be more than 400m guns in the US, 98% of them owned by civilians.

Hate crimes and terrorism are another explanation for mass murders. In these instances, the gunman makes his motive obvious: there are social media announcements, or the site of the shooting is a synagogue, a mosque, or a location where the victims are a specific race or religion. But hate may come out of a psychotic illness, and easy access to firearms allows these crimes to continue.

Firearms are now the number one cause of mortality in children. Very few of these deaths are the result of mass murders. Many more are from accidental deaths, targeted crime, or suicide. Still, school shootings rip at our hearts. Neither the victims or their grieving families have any role in the act, and suffering leaves its mark on families, communities, and all of us.

Universal background checks and tracking gun purchases in the way we monitor controlled medications, or even Sudafed, might allow authorities to predict who might be at risk of committing these crimes.

In psychiatry, we struggle with school shootings. Our hearts ache as we hold our children close and empathise with the loss of strangers who have been through the unthinkable. We help our patients as they process their emotions. And we wonder whether any of our patients might ever do anything so horrific. The feelings get complicated, the sadness and anger intermingle while the frustration builds, and we are left with our fears and the hope that if that very rare person were to walk through our office door, we would know what to do.

Dinah Miller, MD, is a coauthor of Committed: The Battle Over Involuntary Psychiatric Care (Johns Hopkins University Press, 2016). She has a private practice and is an assistant professor of psychiatry and behavioural sciences at Johns Hopkins in Baltimore.


Don’t Equate Mass Shootings With Mental Illness (Open access)


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